Abstract Background Malaria transmission in Uganda is heterogenous, so the national malaria program needs information about the distribution of malaria to develop appropriate policies. While population-based community surveys estimate Plasmodium falciparum parasite rate ( Pf PR), they are too infrequent and sparse for routine malaria management. Health facility data is routinely collected and covers a large geographic scope, but the data is collected passively, variable in quality, and potentially highly biased. We aimed to triangulate test positivity rate (TPR) from health facility data to survey estimated Pf PR data in Uganda to create monthly, high-resolution Pf PR estimates. Methods Using matched health facility and survey data, we fit a multi-level logistic regression model that accounted for clustering at the district and region level, to predict Pf PR from TPR. Additional covariates were explored to select a final model that reduced bias while prioritizing its utility for programmatic tasks. Model predictions were validated against observed Pf PR and used to generate monthly district-level prevalence estimates from 2016 to 2024. Regional and national level estimates were made by weighting district level estimates by population. Results The final model included a smoothed TPR term and proportion of severe malaria cases at a district-month level. Predicted Pf PR was strongly positively correlated with the observed survey Pf PR (Pearson’s rank correlation rho =0.79, p<0.001). National estimates derived from predicted Pf PR aligned well with survey estimates from the same time and area. Conclusion Health Management Information System (HMIS) data, when paired with research data, can be used to estimate malaria prevalence with high spatial and temporal resolution. Estimates can be tested and models can be updated to help malaria programs best leverage facility data. In the context of declining survey frequency, HMIS-based modeling offers a resilient and cost-effective alternative for malaria surveillance and programmatic decision-making in Uganda and similar high-burden settings.

We aimed to develop and validate a tool to comprehensively measure person-centered antenatal care (PCANC) in low- and middle-income countries (LMICs). We followed standard procedures for scale development, including literature review, expert reviews, cognitive interviews, and pretesting to ensure content validity. Questions were iteratively revised at each stage and administered in surveys with pregnant and postpartum women in Ghana and Kenya. The survey data were used for psychometric analysis, resulting in a 36-item PCANC scale with three subscales: “dignity and respect,” “communication and autonomy,” and “responsive and supportive care.” The Cronbach’s alpha is 0.90 for the full scale and >0.7 for each subscale. The summative PCANC scores correlate with global measures of antenatal care quality, satisfaction, and future care location, suggesting good criterion validity. The PCANC scale has high validity and reliability and will facilitate efforts to measure and improve respectful and responsive antenatal care in LMICs.

BackgroundMobility challenges HIV prevention efforts through associated risk behaviours and sexually transmitted infections (STIs). We characterized relationships between mobility and sexual risks on STI prevalence over time in East Africa.MethodsGeospatial mobility and sexual risk behaviours were collected in 12 communities using a sex- and HIV-stratified random sub-sample of 2750 adults from a longitudinal cohort (2015-2019) of a HIV test-and-treat trial in Kenya and Uganda. Annual Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing was performed and relationships of prevalent STIs with mobility, sexual concurrency, and higher HIV-risk sexual partners (defined as one night stand, stranger, commercial sex worker/client, casual partner, or inherited partner/inheritor) were examined.ResultsThe annual prevalence of CT or NG among 2665 participants tested was 3.1% (95% CI: 2.5-3.9) at baseline, 3.3% (95% CI: 2.6-4.0) at year 1, 4.4% (95% CI: 3.0-5.2) at year 2, and 4.8% (95% CI: 4.0-5.7) at year 3. STI (CT, NG) prevalence was associated with migration in the past year, sexual partnership concurrency, being single, higher HIV-risk partners, age >25, low household wealth, and the relationship between gender and work-related travel in past 6 months. The association between select STI prevalence and past 6-months travel was mediated by higher HIV-risk sexual partners, partnership concurrency, out-of-town partner, and higher HIV-risk transactional sex partners.ConclusionsGeospatial mobility, sexual concurrency, and higher HIV-risk partnerships significantly influence longitudinal CT and/or NG prevalence in East Africa.

Background:High-quality postnatal care (PNC), including Person-centered postnatal care (PCPNC), is essential to achieving optimal maternal and neonatal outcomes. PCPNC refers to postnatal care that is respectful of and responsive to postpartum women's preferences, needs, and values. While interest in person-centered care across the reproductive health continuum has increased, there are no validated tools to comprehensively measure PCPNC. This study aims to develop and validate a tool to comprehensively measure PCPNC that is relevant to the experiences of women in low- and middle-income countries (LMICs). Methods:The adaptation and validation process included a literature review to define, construct, and develop the scale items. This was followed by expert reviews with maternal health experts, health care providers, and women with past postnatal care experience to assess content validity. We then conducted cognitive interviews with postpartum women to ensure the questions were relevant, clear, and understandable. We iteratively revised the questions at each stage and surveyed 268 postpartum women (who gave birth within the last six months) in the Upper East Region of Ghana for initial analysis. We then analyzed the data, which informed additional edits to the questions. The final questions were administered in a survey to 1,394 women in Ghana and Kenya who had received postnatal care within 12 weeks postpartum. Psychometric analysis was used for item reduction and to assess construct and criterion validity and internal consistency reliability. Results:Following iterative factor analysis, we developed a 38-item PCPNC scale. The 38 items load onto one dominant factor, with three factors having eigenvalues greater than one and Cronbach alpha of 0.93. We grouped the items into three conceptual domains representing "dignity and respect," "communication and autonomy," and "responsive and supportive care" subscales, each of which has Cronbach alpha > 0.7. PCPNC scores are associated with satisfaction with PNC and intent to receive PNC in the same health facility in the future, suggesting good criterion validity. Conclusions:The PCPNC scale is a valid and reliable tool to measure respectful and responsive PNC and will thus facilitate efforts to monitor and improve women and their baby's experiences during PNC.

Dihydroartemisinin-piperaquine is increasingly used for malaria treatment and chemoprevention in children with HIV co-infection. Its efficacy and safety are associated with piperaquine exposure, which can be compromised by drug-drug interactions with antiretroviral therapy. In a prospective, open-label study, we evaluated the pharmacokinetics of piperaquine following a 3-day standard dihydroartemisinin-piperaquine regimen in malaria-uninfected Ugandan children living with HIV receiving either dolutegravir-, lopinavir/ritonavir-, or efavirenz-based antiretroviral therapies. Children without HIV aged 11-17 and 3-10 years were enrolled as control groups to match (a) the dolutegravir and (b) lopinavir/ritonavir and efavirenz groups, respectively (n = 30 per group). Intensive pharmacokinetic sampling for piperaquine over 42 days was completed. Compared to controls, overall piperaquine exposure, as measured by area under the concentration-time curve from the 3rd dihydroartemisinin-piperaquine dose to 42 days in the dolutegravir group was similar but terminal piperaquine concentrations were reduced by 32% on day 28 (P = 0.02) and 64% on day 42 (P < 0.0001). In contrast, overall piperaquine exposure in the lopinavir/ritonavir group increased by 240% (P < 0.0001), with day 42 concentration increasing by 91% (P < 0.0001), while exposure with efavirenz was reduced by 69% (P < 0.0001), with day 42 concentration reducing by 92% (P < 0.0001). Electrocardiographic monitoring during co-administration with lopinavir/ritonavir identified two transient grade 3 changes that resolved. Efavirenz and lopinavir/ritonavir have opposing effects on piperaquine exposure in children living with HIV, which may impact efficacy and toxicity, respectively, although co-administration in this study did not yield concerning safety findings. Dolutegravir reduced only terminal concentrations significantly, which may shorten the duration of post-treatment chemoprophylaxis.

Background Person-centered maternal health care (PCMHC), responsive and respectful care across the pregnancy, childbirth, and postpartum continuum, is essential for improving maternal and neonatal outcomes. We examined the extent of PCMHC and associated factors in Kenya and Ghana. Methods We used data from cross-sectional surveys conducted between March and October 2024 with 1999 postpartum women in Ghana (n = 1000) and Kenya (n = 999) within 12 weeks of birth. PCMHC was measured using summative scores from validated person-centered antenatal care (PCANC), maternity care (PCMC), and postnatal care (PCPNC) scales. Scores were standardized to range from 0 to 100, with higher scores indicating better care experience. Mixed-model multivariable linear regression analyses were used to identify factors associated with PCMHC across phases of care. Findings Average standardized scores were 71.5 (SD = 16.4) for PCANC; 71.7 (SD = 15.2) for PCMC; and 71.4 (SD = 15.7) for PCPNC. Communication and autonomy subdomain scores were the lowest at each phase of care. Less than 20% of women received optimal PCMHC (scores ≥ 90) across any phase of care: 13.1% (n = 260), 12.7% (n = 254), and 13.6% (n = 189) for PCANC, PCMC, and PCPNC, respectively. Women of higher socioeconomic status, those who received care in health centers or faith-based facilities (compared to public hospitals), and those who reported greater care continuity had higher PCMHC scores. Interpretation PCMHC is suboptimal across maternal care phases, with vulnerable women experiencing the poorest care. Targeted interventions such as provider training, fostering enabling facility environments, accountability mechanisms, and care continuity are needed to improve PCMHC and address disparities throughout the maternal care continuum. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development R01 grant to PA [R01 HD110370-02].

Achieving viral suppression among pregnant and breastfeeding women with HIV is essential to promoting their health and eliminating vertical transmission of HIV. We hypothesized that a multicomponent and peer-led intervention would increase viral suppression among pregnant and breastfeeding women with HIV in the rural Southwestern Uganda. The ENHANCED-SPS intervention included the development of a counseling protocol, point-of-care viral load testing, and standardized support delivered by peer-mothers. Among 505 pregnant and postpartum women receiving the ENHANCED-SPS intervention (2019-2021), we evaluated the change in viral suppression (HIV RNA < 1000 c/mL) from baseline to 12 months of follow-up with targeted minimum loss-based estimation, accounting for clustering and missing outcomes. The proportion with viral suppression was 70.0% (95% CI: 65.9, 74.1%) at baseline and 94.9% (95% CI: 92.5, 97.4%) at 12 months, corresponding to a 24.9% (95% CI: 21.6, 28.2%; P < 0.001) absolute increase over time. Significant improvements over time were observed across age groups (15-24 years, 25-34 years, and 35+ years) and for both pregnant and postpartum women. Approximately 95% of women in all age groups and pregnant women achieved viral suppression at 12 months. However, postpartum women lagged behind with only 75.7% viral suppression at 12 months, despite a 58.9% (95% CI: 27.4, 90.3%) increase from baseline. The multicomponent, peer-led ENHANCED-SPS intervention resulted in meaningful improvements in viral suppression for pregnant and breastfeeding women with HIV; however, additional support is needed during the postpartum period.

Background:Person-centered antenatal care (PCANC)-antenatal care that is respectful and responsive to people's needs, values, and preferences-is essential to achieving optimal pregnancy outcomes. Yet, no validated tools exist to comprehensively measure PCANC in low- and middle-income countries (LMICs). We aim to develop and validate a tool to comprehensively measure PCANC relevant to women's experiences in LMICs. Methods:We followed standard procedures for scale development. This included a literature review to adapt items from a prior scale developed in the United States and to generate new items relevant to LMICs; expert reviews with maternal health experts, health care providers, and women with lived experiences (currently pregnant or previously pregnant) to assess content validity; and cognitive interviews and pretesting with pregnant and postpartum women to evaluate clarity, appropriateness, and relevance of the questions. Questions were iteratively revised at each stage and administered in a survey to 300 pregnant (third trimester) and 300 postpartum women (who gave birth within six months of the interview) in the Upper East Region of Ghana. Following data analysis from the first survey, the questions were revised and administered to 2000 postpartum women in Ghana and Kenya (1000 per country). The survey data were used in psychometric analysis to assess construct and criterion validity, and internal consistency reliability. Results:Iterative exploratory factor analysis was used to reduce the number of items from over 60 to 36. The 36 items load onto one dominant factor, with three factors having eigenvalues greater than one. Items are grouped into three conceptual domains representing subscales for "dignity and respect," "communication and autonomy," and "responsive and supportive care." The Cronbach's alpha for the full scale is 0.90, and the subscales are each > 0.7. The summative PCANC scores correlate with global measures of antenatal care quality, satisfaction, and future care location, suggesting good criterion validity. Conclusions:The PCANC scale has high validity and reliability in the sample of prenatal and postpartum women in Ghana and Kenya. This scale will facilitate efforts to measure and improve respectful and responsive antenatal care in LMICs.

Mosquito ecology and behavior and malaria parasite development display marked sensitivity to weather, in particular to temperature and precipitation. Therefore, climate change is expected to profoundly affect malaria epidemiology in its transmission, spatiotemporal distribution and consequent disease burden. However, malaria transmission is also complicated by other factors (e.g. urbanization, socioeconomic development, genetics, drug resistance) which together constitute a highly complex, dynamical system, where the influence of any single factor can be masked by others. In this study, we therefore aim to re-evaluate the evidence underlying the widespread belief that climate change will increase worldwide malaria transmission. We review two broad types of study that have contributed to this evidence-base: i) studies that project changes in transmission due to inferred relationships between environmental and mosquito entomology, and ii) regression-based studies that look for associations between environmental variables and malaria prevalence. We then employ a simple statistical model to show that environmental variables alone do not account for the observed spatiotemporal variation in malaria prevalence. Our review raises several concerns about the robustness of the analyses used for advocacy around climate change and malaria. We find that, while climate change's effect on malaria is highly plausible, empirical evidence is much less certain. Future research on climate change and malaria must become integrated into malaria control programs, and understood in context as one factor among many. Our work outlines gaps in modelling that we believe are priorities for future research.

Adherence to antiretroviral therapy (ART) and disclosure of HIV status are critical for achieving HIV viral suppression and eliminating perinatal transmission of HIV. The ENHANCED-SPS intervention was designed to address barriers to viral suppression among pregnant and postpartum women with HIV and included standardized support and counseling though phone calls by peer-mothers. Using targeted minimum loss-based estimation (TMLE), we evaluated changes in adherence ($\le$1 dose of ART missed per month) and HIV status disclosure (to anyone and to a spouse or partner) among 505 pregnant and postpartum women with HIV who received the ENHANCED-SPS intervention in rural Uganda (2019-2021). ART adherence was 68% (95% CI, 62-74) at baseline and increased to 93% (95% CI, 81-100) after 12 months, corresponding to a 25% increase (95% CI, 9-40; P = .009). Largest improvements were among participants who were aged 15-24 years, breastfeeding, or without viral suppression at enrollment. At baseline, 80% (95% CI, 69-90) had disclosed their HIV status to anyone—increasing to 94% (95% CI, 89-99) after 12 months and corresponding to a 14% improvement (95% CI, 8-21; P = .003). Similar trends were observed for disclosure to a spouse or partner. Among pregnant and postpartum women with HIV in rural Uganda, the ENHANCED-SPS intervention was associated with meaningful improvements in ART adherence and HIV status disclosure after 1 year.

BACKGROUND:Peer-led counseling interventions could improve early infant diagnosis of HIV by empowering mothers with knowledge and information on their role in preventing perinatal transmission. We hypothesized that a peer-led intervention would increase completion rates of infant HIV testing in rural Uganda. METHODS:From September 2019 to October 2021, we conducted the Enhanced viral load counseling with Standardized Peer-Support (ENHANCED-SPS) trial, which randomized 14 public health facilities to the intervention: peer-led counseling on HIV viral load and perinatal transmission, support for status disclosure and treatment adherence, and point-of-care viral load testing; or control: HIV care per national guidelines (NCT04122144). We retrospectively reviewed medical records of all infants born to ENHANCED-SPS participants during the 1-year follow-up and compared the proportions completing final testing (antibody rapid test at 18 months) between arms with targeted minimum loss-based estimation. Secondary outcomes included completion of earlier steps in the testing algorithm for the HIV-exposed infants. RESULTS:Among 464 children (intervention = 234 and control = 230) born to trial participants, the proportions completing final testing were 94.5% (95% CI: 91.6-97.5%) in the intervention and 83.3% (95% CI: 78.4-88.3%) in the control: a difference of 11.2% (CI: 5.4-17.0%; P < 0.001). There were no differences in the proportions completing the 1st test (at 4-6 weeks) or the 2nd test (at 9 months), but completion of the 3rd test (6 weeks after breastfeeding cessation) was 14.8% (95% CI: 7.9-21.8%; P < 0.001) higher in the intervention. CONCLUSIONS:Peer-led counseling on the mother's role in ensuring a healthy baby reduced drop-offs in infant HIV testing, which is progress toward improved infant diagnosis and prompt linkage to care.

Long-lasting insecticidal nets (LLINs) form a physical and chemical barrier against mosquitoes and have been shown to reduce malaria burden and mortality. Many countries, Uganda inclusive have distributed LLINs free of charge, drastically increasing LLIN ownership. However, ownership does not directly translate in to LLIN use. Data from serial cross-sectional surveys were obtained from LLIN Evaluation in Uganda Project (LLINEUP); a cluster-randomized trial conducted in eastern and western Uganda. We apply the Vaccine Economics Research for Sustainability and Equity (VERSE) Toolkit to analyze LLIN usage and equity among household members before and after a nationwide mass distribution campaign in 48 districts. Overall, the proportion of household members who slept under a bed net a night prior to survey reduced from 85.4

People with chronic illnesses such as Human Immunodeficiency Virus (HIV), hypertension, and Diabetes Mellitus (DM) are a priority for Coronavirus disease (COVID-19) vaccination due to elevated risk of severe disease. We explored the perspectives and experiences of COVID-19 vaccination among these priority populations in Southwestern and Southcentral Uganda. Between January and April 2023, we conducted in-depth interviews with adult (≥18 years) persons living with HIV (PLWH), hypertension and/or DM (n = 30) and key informant interviews with healthcare providers and managers (n = 12) at Mbarara and Masaka Regional Referral Hospitals. We used the Behavioral and Social Drivers model to explore the factors that influenced COVID-19 vaccination. We coded the data using Dedoose software and analyzed them using thematic deductive analysis. Motivations to take the COVID-19 vaccine included fear of COVID-19, observing the effect of COVID-19 or the vaccine on others, vulnerability from underlying illnesses, family and social support, health worker recommendation, vaccine benefits and trust in the vaccine. Fear of side effects and vaccine interactions with antiretroviral, antihypertensive or antidiabetic medications, misinformation, rapid vaccine development and rollout, inadequate sensitization, and healthcare providers’ hesitancy hindered uptake. Furthermore, health system challenges like stockouts and long queues hindered uptake or dose completion. Fear of COVID-19, trust in the vaccine, family and social support facilitated COVID-19 vaccination uptake. Conversely, fear of side effects, vaccine and medication interaction, misinformation and inadequate sensitization hindered vaccine uptake. Effective communication strategies involving health workers and community leaders and sustained vaccine supply are crucial to improve COVID-19 vaccine uptake.

Background Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda. Methods A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death. Results The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis ( n = 53, 6.1%); had their urine tested for glucose and proteins ( n = 27, 3.1%); undertook an ultrasound scan ( n = 262, 30%); and had their maternal status assessed ( n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care ( n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1–35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1–0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period. Conclusion Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it’s lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.

BackgroundAdherence to antiretroviral therapy (ART) can substantially reduce morbidity and mortality among women living with HIV (WLWH) and prevent vertical transmission of HIV. However, in sub-Saharan Africa (SSA), more than 50% of new mothers discontinue ART and HIV care after childbirth. The role of water insecurity (WI) in ART adherence is not well-explored. We examined the relationship between WI and ART adherence among pregnant and postpartum WLWH in Greater Accra region of Ghana.MethodsUsing a cross-sectional survey, we recruited 176 pregnant and postpartum WLWH on ART across 11 health facilities. We examined the association between WI (measured using the Household Water Insecurity Experience Scale, and categorized as moderate and severe WI compard to low WI) and poor ART adherence (defined as scoring a below average observed CASE index score). Bivariate analysis was performed using chi-square test followed by multivariate logistic regression models. We included all variables with p-values less than 0.20 in the multivariate analysis.ResultsMost (79.5%) of the pregnant and postpartum WLWH enrolled on ART, were urban residents. Over 2/3 were aged 30 years and older. Overall, 33.5% of respondents had poor ART adherence. Proportion of poor ART adherence was 19.4% among those with low WI, 44.4% in those with moderate WI, and 40.0% among those with high WI. Respondents with moderate household water insecurity had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (adjusted Odds ratio (aOR) = 2.76, 95%CI: 1.14-6.66, p = 0.024), even after adjusting for food insecurity. Similarly, respondents with high WI had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (aOR = 1.49, 95%CI: 0.50-4.48, p = 0.479), even after adjusting for food insecurity.ConclusionWater insecurity is prevalent among pregnant and postpartum WLWH and is a significant risk factor for poor ART adherence. Governments and other stakeholders working in HIV care provision should prioritize water security programming for WLWH along the HIV care continuum.

Background: HIV self-testing (HIVST) is a practical and effective way to provide HIV testing services to at-risk and underserved populations, particularly men. Utilizing Village Health Teams (VHTs) could enhance community-based delivery of oral HIVST to reach the last un-tested individuals who may be at-risk of infection. However, little is known about what VHTs and facility-based healthcare workers think about facilitating oral HIVST and delivery of subsequent HIV services. We investigated the views of health providers on oral HIVST delivered by VHTs among men in rural communities in Central Uganda. Methods: We conducted a qualitative study in Mpigi district, interviewing 27 health providers who facilitated oral HIV self-testing among men. The providers consisting of 15 VHTs and 12 facility-based health workers were purposively selected. All interviews were audio-recorded, transcribed verbatim, and translated to English for a hybrid inductive-deductive thematic analysis. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Implementation Science framework to generate and categorize open codes. Results: In terms of reaching men with HIV testing services, the providers considered HIVST to be a fast and convenient method, which could boost HIV testing. However, they also had concerns about its accuracy. In terms of effectiveness, HIVST was perceived as a reliable, user-friendly, and efficient approach to HIV testing. However, it depended on the user's preference for testing algorithms. Regarding adoption, HIVST was considered to enhance autonomy, well-suited for use in the community, and offered opportunities for linkage and re-linkage into care. However, at times HIVST faced hesitance. As for Implementation, VHTs had various support roles in HIVST but had concerns about social insecurities and delays in seeking subsequent facility-based services after HIVST. Regarding Maintenance, providers recommended several ways to improve oral HIVST including; optimizing tracking of HIVST distribution and use, improving linkage and retention in care after HIVST, diversifying HIVST for combined HIV prevention packages and including more languages, broadening sensitization among potential HIVST users and health providers, differentiating distribution models, and prioritizing targeted HIVST efforts. Conclusion: HIVST has the potential to increase testing rates and engagement of men in HIV services. However, for it to be implemented on a population-wide scale, continuous sensitization of potential users and health providers is necessary, along with streamlined structures for tracking kit distribution, use, and reporting of results. Further implementation research may be necessary to optimize the role of health providers in facilitating HIVST.

Chronic diseases such as HIV, hypertension, and diabetes increase the risk of severe coronavirus disease 2019 (COVID-19) and death. Thus, COVID-19 vaccine uptake data among these priority populations are needed to inform immunization programs. We assessed COVID-19 vaccine uptake among people living with HIV (PLWH) and those with hypertension/diabetes without HIV (PWoH) in Southwestern and Southcentral Uganda and determined factors influencing vaccination. We conducted a cross-sectional study from January to April 2023. We enrolled a random sample of participants aged 18 years and older seeking HIV, hypertension, or diabetes care at two regional referral hospitals (RRHs) in Mbarara and Masaka in Uganda. Using vaccination records abstraction and interviewer-administered questionnaires, we collected data on COVID-19 vaccine uptake, sociodemographic data, and reasons for non-uptake in unvaccinated persons. We compared COVID-19 vaccination uptake between PLWH and PWoH and applied modified Poisson regression to determine sociodemographic factors associated with vaccine uptake. The reasons for non-vaccine uptake were presented as percentages. Of the 1,376 enrolled participants, 65.6% were fully vaccinated against COVID-19. Vaccination coverage was 65% among PWLH versus 67% among PWoH. Higher education attainment and older age were associated with COVID vaccination. Participants with secondary education and those aged ≥50 years achieved >70% coverage. Fear of side effects was the most cited reason (67%) for non-vaccination among 330 unvaccinated participants, followed by vaccine mistrust (24.5%). People with chronic diseases in Southwestern Uganda had slightly lower than 70% COVID-19 vaccine coverage as recommended by WHO. Higher educational attainment and older age were linked to increased vaccine uptake. However, mistrust and fear of vaccine side effects were the main reasons for non-vaccination. To increase COVID-19 vaccine uptake, programs must reach those with lower educational attainment and younger age groups, and address the fear of vaccine side effects and mistrust among persons with underlying diseases in Uganda.

Abstract Background Reports on the impact of COVID-19 pandemic on the quality of malaria care and burden in sub Saharan Africa have provided a mixed picture to date. The impact of the 2nd (Delta) and 3rd (Omicron) COVID-19 waves on outpatient malaria indicators and case management practices was assessed at three public health facilities with varying malaria transmission intensities in Uganda. Methods Individual level data from all patients presenting to the out-patient departments (OPD) of the three facilities (Kasambya, Walukuba and Lumino) between January 2019 and February 2022 were included in the analysis. Outcomes of interest included total number of outpatient (OPD) visits, proportion of patients suspected to have malaria, proportion of suspected malaria cases tested with a malaria diagnostic test, test positivity rates (TPR) and proportion of malaria cases prescribed artemether-lumefantrine (AL). Using the pre-COVID-19 trends between January 2019 and February 2020, interrupted time series analysis was used to predict the expected trends for these study outcomes during the 2nd wave (May 2021–August 2021) and 3rd wave (November 2021–February 2022). The observed trends of the study outcomes were compared with the expected trends. Results There were no significant differences between the observed versus expected overall outpatient visits in the 2nd wave, however, a significant decline in OPD attendance was observed during the 3rd wave (15,101 vs 31,154; incidence rate ratio (IRR) = 0.48 [0.41–0.56]). No significant differences in the overall observed versus expected proportions of suspected malaria cases and test positivity rates in both COVID waves. However, a significant decrease in the overall proportion of suspected malaria cases tested with a malaria diagnostic test was observed during the 3rd wave (99.86% vs 99.99%; relative percent ratio [RPR] = 0.99 [0.99–0.99]). Finally, a significant decline in the overall proportion of malaria cases prescribed AL was observed during the 2nd wave (94.99% vs 99.85%; RPR = 0.95 [0.92–0.98]) but not the 3rd wave. Conclusion Significant declines in OPD attendance and suspected malaria cases tested with malaria diagnostic test were observed during the 3rd COVID-19 wave, while AL prescription significantly reduced during the 2nd COVID-19 wave. These findings add to the body of knowledge highlighting the adverse impact of COVID-19 pandemic on the malaria which could explain the increase in the malaria burden observed during this period.